Pyoderma Vegetans of the Perineum in the Setting of Ulcerative Colitis

摘要

A 51-year-old man who had undergone total proctocolectomy with ileoanal anastomosis for ulcerative colitis (UC) 6 years prior presented with extensive nonitchy perianal lesions of 5-month duration (Figure ). He was undergoing regular follow-up via anoscopy and pouchoscopy with mucosal biopsies to rule out recurrence and pouchitis, respectively; these were negative each time. His stool frequency was 5–7 per day. There was no any other significant medical history, extraintestinal manifestations of UC, and he was not on any other medications that could cause an adverse drug reaction. On examination, there was extensive tender perianal excoriation with erosions and a serosanguinous discharge. A biopsy from the lesion revealed pseudoepitheliomatous hyperplasia, fibrosis, vascular proliferation, neutrophilic infiltration, and eosinophilic microabscesses (Figure ). Periodic acid–Schiff and lipophosphoglycan stains were negative. Immunohistochemical examination with CD68 stain revealed no granuloma formation. Based on the clinical and histopathological findings, the patient was diagnosed as having pyoderma vegetans (PV). He was started on systemic steroids, amoxicillin clavulanate 1 g twice daily, and topical wound care with zinc oxide dressing. The lesions healed well over 3 weeks.